초록접수 현황
| 17F-185 | 구연 발표 |
Roll of Intraoperative Motor-evoked Potentials and Postoperative Paraplegia in Thoraco-abdominal Aortic Aneurysm Surgery
Heemoon Lee, Kiick Sung, Yang Hyun Cho, Dong Seop Jeong, Wook Sung Kim, Young Tak Lee, Pyo-Won Park
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Purpose : For preventive strategy for spinal cord ischemia, intraoperative motor-evoked potentials (MEPs) monitoring has been widely used in thoraco-abdominal aortic aneurysm(TAAA) surgery. Herein, we evaluated the results and adequacy of MEP monitoring.
Methods : Between 1997 and 2016, 80 patients who underwent TAAA surgery under MEP monitoring and reviewed retrospectively. The mean age was 53.0±16.5 years.
Results : There were 2 early mortality(2.5%). Significant MEP changes were detected in 24 patients and undetected in one patient. MEP was fully recovered in 19 patients and were not fully recovered in 5 patients. Immediate postoperative paraplegias occurred in 5 patients(6.3%). Immediate postoperative paraplegias occurred in 2 patients significant intraoperative MEP was not fully recovered and in 3 patients with no significant intraoperative MEP change. Among 3 normal MEPs, One patient had hypotensive events and one patient had impaired CSF drainage in the immediate postoperative period. Permanent paraplegias were developed in 2 patients. Delayed paraplegias were occurred in 4 patients(5.0%). Delayed paraplegias were occurred in 2 patients with no significant intraoperative MEP change and in 2 patients with significant intraoperative MEP change. All patients with delayed paraplegia treated with CSF drainage, volume replacement and vasopressor support. All patients with delayed paraplegia fully recovered successfully.
Conclusion : Intraoperative MEP monitoring is effective technique to detect spinal cord ischemia during TAAA surgery. However, MEP monitoring cannot detect or predict all postoperative neurologic deficits. Other preventive strategies for spinal cord injury such as CSF drainage or maintaining a high blood pressure should be also applied to prevent or treat postoperative paraplegia.
Methods : Between 1997 and 2016, 80 patients who underwent TAAA surgery under MEP monitoring and reviewed retrospectively. The mean age was 53.0±16.5 years.
Results : There were 2 early mortality(2.5%). Significant MEP changes were detected in 24 patients and undetected in one patient. MEP was fully recovered in 19 patients and were not fully recovered in 5 patients. Immediate postoperative paraplegias occurred in 5 patients(6.3%). Immediate postoperative paraplegias occurred in 2 patients significant intraoperative MEP was not fully recovered and in 3 patients with no significant intraoperative MEP change. Among 3 normal MEPs, One patient had hypotensive events and one patient had impaired CSF drainage in the immediate postoperative period. Permanent paraplegias were developed in 2 patients. Delayed paraplegias were occurred in 4 patients(5.0%). Delayed paraplegias were occurred in 2 patients with no significant intraoperative MEP change and in 2 patients with significant intraoperative MEP change. All patients with delayed paraplegia treated with CSF drainage, volume replacement and vasopressor support. All patients with delayed paraplegia fully recovered successfully.
Conclusion : Intraoperative MEP monitoring is effective technique to detect spinal cord ischemia during TAAA surgery. However, MEP monitoring cannot detect or predict all postoperative neurologic deficits. Other preventive strategies for spinal cord injury such as CSF drainage or maintaining a high blood pressure should be also applied to prevent or treat postoperative paraplegia.
책임저자: Kiick Sung
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
발표자: Heemoon Lee, E-mail : rhythmists@gmail.com